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22 Diagnosing Corruption in Ethiopia
building collapses, the headlines focus on resulting deaths and any allegations
of corruption. But when substandard drugs are prescribed, the
press rarely reports on the resulting deaths, let alone links those deaths
to potential corruption.
Difficulty of Detecting Health Sector Corruption
Health care services have specific features that make corruption difficult
to detect and even more difficult to prove:
• Health care services are delivered in highly dispersed locations by large
numbers of people engaged in numerous transactions. In Ethiopia, for
example, public funds are used to provide health care services in 143
hospitals, 690 health centers, and more than 10,000 health posts for a
population of 82 million with a public sector staff of more than
50,000.
• Health care services are highly varied and patient specific. Individuals
do not go to a health facility to buy a particular service. Instead,
health professionals diagnose the individuals and tell them what
treatment they need. Patients are rarely equipped to question the
health professional’s judgment or to assess diagnoses from alternative
practitioners. In any country, people can be manipulated about
what to buy, how much they should pay, and what their rights are
in terms of public service provision. In Ethiopia, widespread illiteracy
and low school enrollment exacerbate this susceptibility to
manipulation.
• Health care provision is inherently uncertain. No diagnosis is perfect,
and no treatment is foolproof. If an individual’s health fails to
improve after treatment, it is not clear whether the diagnosis was
mistaken, drugs were substandard, or the individual’s particular condition
was unresponsive. People sometimes regain their health even
without treatment, just as those who receive treatment might not
recover.
Impact of Health Sector Corruption
Corruption, when it occurs, creates serious problems in health systems,
especially in low-income countries like Ethiopia. As in other sectors,
health sector corruption diverts resources from their intended uses.
Ethiopia spends about US$8 per person 1 on health each year, among the
lowest amounts in the world, and every penny stolen cuts further into
limited health care resources.